Provider Demographics
NPI:1841650835
Name:ROBERTS, BENDU NORWU
Entity type:Individual
Prefix:MS
First Name:BENDU
Middle Name:NORWU
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N HWY 360
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1011
Mailing Address - Country:US
Mailing Address - Phone:971-226-1892
Mailing Address - Fax:
Practice Address - Street 1:2100 N HWY 360
Practice Address - Street 2:SUITE 1105
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1011
Practice Address - Country:US
Practice Address - Phone:971-226-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle